Clinical Analysis Of Vaginal Delivery And Outcome After Cesarean Section

Objective: To explore the feasibility and safety of vaginal delivery(Vaginal birth after cesarean,VBAC)in women who are pregnant again after cesarean section,so as to provide certain clinical reference value for the selection of delivery mode and reduction of cesarean section rate of scar uterine mothers,and further improve clinicians' understanding of VBAC.Methods: A total of 84 cases of pregnant women who had a second vaginal delivery(VBAC)after cesarean section and were hospitalized on April 1,2018 and September30,2018 were selected as the VBAC group.15 cases of Trial of labor after cesarean section(TOLAC)failure were selected as the TOLAC failure group,81 cases of first-time vaginal delivery women without cesarean section during the same period were selected as the VBNC group,and 82 cases of Elective repeat cesarean section(ERCS)were selected as the ERCS group.The latter three groups were the control group,and the clinical data of the four groups were collected.The parturient durations,postpartum blood loss,antibiotic use rate,hospitalization time,hospitalization cost,pregnancy outcome,neonatal Apgar score,body mass and other relevant indicators were analyzed.Results:1.The success rate of vaginal trial-birth of the second pregnancy after cesarean section was higher(84.85%,84/99),and the postpartum hemorrhage of vaginal delivery was less,the length of hospital stay was shorter,the hospitalization cost was lower,and the use of antibiotics was lower.No serious postpartum complications occurred in each group.2.VBAC failure group compared with the VBNC group,two groups in terms of postpartum hemorrhage,length of hospital stay,hospital expenses is no statistical difference(P > 0.05),but the two groups in the labor time,artificial intervention rate,episiotomy rate and utilization rate of forceps are statistically significant(P < 0.05),VBAC failure group of labor time is shorter,the rate of artificial intervention,perineotomy and forceps usage were higher.3.There was no statistically significant difference in age between the four groups(P >0.05),but there were statistically significant differences in gestational weeks,gestational times,and body mass index(BMI)(P <0.05).4.There was no significant difference in Apgar score among the four groups(P >0.05).The neonatal body mass of ERCS group was significantly higher than that of VBAC group,VBNC group and TOLAC failure group,and the difference was statistically significant(P <0.05),but the neonatal body mass of the latter three groups was not statistically significant(P >0.05).5.Compared with the vaginal delivery group(including VBAC and VBNC group),the postpartum blood loss,antibiotic use rate and hospitalization cost in the cesarean section group(including ERCS and TOLAC failed cesarean section group)were all higher than those in the vaginal delivery group,with statistical significance(P<0.05).The postpartum blood loss and hospitalization cost were the highest in the TOLAC failed group.The length of hospital stay in ERCS group was significantly higher than that in the other three groups,and the length of hospital stay in VBAC group and VBNC group was lower than that in TOLAC failure group(P<0.05).Incomplete uterine rupture occurred in 1 case in the TOLAC failed to transfer to cesarean section group.6.The natural labor rate was 95.96%(95/99 cases)for TOLAC,and 80.81%(80/99 cases)for VBAC group.Four cases in TOLAC were induced labor with 1.25 u oxytocin,and all of them delivered successfully without adverse outcomes.Conclusion:1.After cesarean section,there was no serious postpartum complications and the success rate of vaginal triage was high.2.The VBAC group had low postpartum blood loss,short hospitalization time,low hospitalization cost and low use of antibiotics,with a better maternal and child outcome,but the TOLAC failure group increased the risk of postpartum blood loss and uterine rupture.3.Under the condition of strict control of indications,it is safe and feasible to strengthen the monitoring of labor process and make good preparation for surgery.The vaginal delivery of the second pregnancy after cesarean section is worthy of clinical promotion and application,but a larger sample size is needed to further confirm the clinical data.